Hawaii Ranks 6th Among All States in Efforts to Serve Individuals with Intellectual and Developmental Disabilities

The Case for Inclusion 2019 Ranks States on Policies and Programs that Encourage Employment and Community Living

News Release from Anchor Foundation, January 9, 2019

WASHINGTON, D.C. – Hawaii has taken steps to improve policies that help individuals with intellectual and developmental disabilities lead more independent and productive lives, moving the state up from 12th place in 2007 to 6th place this year in state rankings compiled by the ANCOR Foundation and United Cerebral Palsy (UCP).

The Case for Inclusion 2019 ranks all 50 states and the District of Columbia on how well state programs, primarily Medicaid, serve those with intellectual and developmental disabilities (I/DD). The states are ranked in five key areas critical to the inclusion, support and empowerment of individuals with I/DD and their families: Promoting Independence, Promoting Productivity, Keeping Families Together, Serving Those in Need, and Tracking Health, Safety & Quality of Life.

Hawaii was one of thirteen states that did not have waiting lists for their residents with I/DD for either residential services or other Home and Community-Based Services. This led to Hawaii tying for 1st in the nation in the area of Serving Those in Need.

By contrast, Hawaii fared significantly worse in the area of Promoting Productivity, where it came in 49th in the nation. Only one percent of Hawaii residents with I/DD were working in competitive employment settings, meaning they work alongside individuals without disabilities and earn market-driven wages. Hawaii placed worst in the nation for this metric.

Nationally, the number of people on waiting lists for Home and Community-Based Services was up 75,000 from the 2016 report to almost 424,000. Just seven states, down from 10 in 2016, reported at least 33 percent of working-age individuals with I/DD working in competitive employment.

“Individuals with I/DD, including the young and the aging, want and deserve the same opportunities and quality of life as all Americans. Yet some states do much better than others in demonstrating the needed political will and implementing the sound policies and focused funding necessary to achieve this ideal,” the report states.

The Case for Inclusion, which has been published regularly since 2006 by UCP, compiles the most recent data available (generally from 2016 for this report) and analyzes 30 outcome measures in the five major categories. The ANCOR Foundation joins UCP this year in publishing the report.

Among the other findings on Hawaii’s performance:

• Hawaii joins thirteen other states and the District of Columbia in having eliminated large, state- run institutions that warehouse individuals with I/DD.

• 85 percent of Hawaii residents with I/DD lived in residences with three or fewer people.

• One in 10 Hawaii residents with I/DD were still employed one year after participating in Vocational Rehabilitation. This is well below the national average of roughly one in three.

• In Hawaii, per-family government investments to ensure individuals with I/DD have the option of living in their family home was an impressive $28,528, roughly two and a half times the national average of $11,060 per family.

Nationally, the report found that notable advances in the support of individuals with I/DD have stalled. For instance, just 29 states—two more than in the 2016 Case for Inclusion—report that at least 80 percent of these Americans are served in home-like settings, such as a family home, their own home or a small group setting—a number that hasn’t budged from the 2016 Case for Inclusion findings. And decades after states embarked on efforts to close large institutions that warehouse the intellectually and developmentally disabled, just 15 states have eliminated all such facilities, a number that is also unchanged from 2016.

Factors driving the stagnating or downward trends include states forgoing Medicaid expansion and growing shortages in Direct Support Professionals (DSPs), the frontline workers who help those with disabilities integrate into the community. “The DSP workforce crisis may be the most significant challenge we face in improving the outcomes tracked by the annual Case for Inclusion,” said ANCOR and ANCOR Foundation CEO Barbara Merrill. “Without the professional staff needed to provide the supports and services that enable people with I/DD to be integrated into the community, provider agencies have little hope of maintaining and expanding on any progress they’ve seen in the past decade.”

It is notable that during a period of polarization on many issues, policies that support individuals with I/DD have support from stakeholders across the political spectrum. For example, the 10 highest-ranked states are a political mix, including deep-blue Oregon and California and deep-red Kentucky and South Dakota. Armando Contreras, President & CEO of UCP, notes that “across the country, we see efforts by state policymakers to enhance their approach to Medicaid services and supports and related programs for the I/DD population by making the best use of existing and scarce resources. Of course, additional funding to keep pace with the diverse needs of this population would help, but new ideas and shared best practices from successful states have the potential to drive improvements even absent additional funding.”

The full Case for Inclusion 2019 report, along with scorecards for each state and additional resources, can be downloaded at caseforinclusion.org.